Abstract:
:Adaptive servo-ventilation (ASV) is a recently-developed non-invasive therapy that improves the clinical course of heart failure (HF) patients. However, the precise hemodynamic response and predictors of ASV therapy remain uncertain. Overall, 69 patients with New York Heart Association HF class II-IV underwent 10-minute ASV testing along with hemodynamic studies. Among them, 21 (30%) achieved an acute response, which was defined as an increase in the cardiac index (CI) during ASV. ΔLeft ventricular end-diastolic pressure (LVEDP) did not correlate with ΔCI, whereas Δtransmural LVEDP, which was calculated by subtracting right ventricular end-diastolic pressure (RVEDP) from LVEDP, and ΔCI were positively correlated, similar to the ascending limb of Frank-Starling's law (P = 0.009, r = 0.311). Among baseline data, higher RVEDP and higher LVEDP were significant predictors of an acute response by logistic regression analyses (P < 0.05 for both). RVEDP had a significantly higher area under the curve than LVEDP in the receiver operating characteristic analyses (0.846 versus 0.673, P = 0.028). Higher baseline RVEDP was significantly associated with a greater decrease in RVEDP during ASV (P < 0.001, r = -0.604). In conclusion, in HF patients with elevated RVEDP, ASV increased cardiac output through a decrease in RVEDP and an increase in transmural LVEDP, according to the ascending limb of Frank-Starling's law.
journal_name
Int Heart Jjournal_title
International heart journalauthors
Imamura T,Kinugawa Kdoi
10.1536/ihj.16-489subject
Has Abstractpub_date
2017-08-03 00:00:00pages
536-543issue
4eissn
1349-2365issn
1349-3299journal_volume
58pub_type
杂志文章abstract::Prognosis of patients with heart failure (HF) remains unclear in Japan and should be determined in a prospective fashion. A prospective cohort of The Shinken Database comprised details on all of the new patients, including both inpatients and outpatients, who visited The Cardiovascular Institute Hospital in 2004-2005....
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